What is the impact of e-cigarettes (electronic cigarettes) on adolescents?

Impact of E-Cigarettes on Adolescents

E-cigarette use poses a clear threat to adolescent public health, with evidence showing deleterious effects on the cardiovascular system, respiratory system, and brain development, while also increasing the risk of addiction and transition to combustible cigarette use. 1

Health Risks to Adolescents

• E-cigarettes contain and emit numerous potentially toxic substances beyond nicotine, including vaporizing solvents, particulate matter, metals, and flavorings that can harm developing bodies 1
• Nicotine is highly addictive and adversely affects children during prenatal development through adolescence, with particular concern for neurodevelopmental effects 1, 2
• Nicotine exposure during adolescence can alter neurologic development and brain structure, as the adolescent brain is particularly vulnerable to its effects 1, 2
• E-cigarette use is associated with increased odds of smoking combustible cigarettes among adolescents who had no previous intention of smoking conventional cigarettes 1, 3
• The introduction of high-nicotine delivery systems such as JUUL has transformed the e-cigarette landscape and increased addiction potential for young people 1, 3

Detection and Concealment Challenges

• E-cigarette use is particularly difficult to detect in adolescents compared to traditional cigarettes due to:
  • Minimal odor that dissipates quickly after use 1
  • Few obvious immediate physical or behavioral signs 1
  • Devices designed to be indiscernible from everyday objects (e.g., USB drives, pens) 1
• This concealment ability allows adolescents to transition from initial exploration into hazardous use without easy detection by parents or healthcare providers 1

Addiction and Quality of Life Impact

• Adolescents describe e-cigarette addiction as causing a loss of control over their routines and activities, along with physical symptoms of reward and withdrawal 4
• Specific characteristics of e-cigarette devices that enhance addiction risk among adolescents include:
  • Flavors (particularly appealing to youth)
  • "Cool" designs and concealable size
  • Low price and ease of use
  • Use of nicotine salts that deliver higher concentrations 4, 5
• Quit attempts are often difficult and usually unsupported by adults or formal cessation aids 4
• For many adolescents, addiction disrupts their routines and reduces their quality of life 4

Risk Factors for E-Cigarette Use

• Social acceptance and use within peer or family circles is one of the strongest risk factors 5
• Male gender is consistently associated with higher rates of use 5
• Low risk perception makes adolescents more vulnerable to initiation 6, 5
• Greater financial resources enable access to these products 5
• Appealing flavors are a significant motivator for adolescent use 5

Association with Other Substance Use

• E-cigarette use is significantly associated with:
  • Smoking initiation of combustible cigarettes 5
  • Cannabis consumption 5
  • Alcohol use 5
• Many adolescents engage in dual use (both e-cigarettes and traditional cigarettes), which compounds health risks 5

Prevention and Intervention Approaches

• School-based prevention programs should:
  • Be grounded in theories that empower adolescents
  • Include normative and interactive education
  • Be easily accessible and free of cost
  • Address key factors driving use, including misperceptions about safety, flavors, nicotine content, and addiction 7
• Parents/guardians talking with adolescents about not using e-cigarettes is associated with greater intention to quit among users 6
• Health warnings on e-cigarette packages that are noticed by adolescents are associated with greater intention to quit 6
• Prevention strategies should target social influences, risk perceptions, and accessibility of these products 5

Clinical Implications

• Healthcare providers should screen for e-cigarette use during all adolescent healthcare visits, recognizing that traditional signs of tobacco use may not be present 1
• Providers should advise adolescents to avoid both smoking and vaping for optimal health outcomes 3
• Evidence-based behavioral strategies should be used to support complete nicotine cessation rather than transitioning to e-cigarettes 8
• Clinicians should discuss with adolescents the potential long-term impacts on brain development, addiction risk, and gateway effects to other substances 2